Provider Demographics
NPI:1407253719
Name:TRIPP, SIRENIA (PHARMD)
Entity Type:Individual
Prefix:
First Name:SIRENIA
Middle Name:
Last Name:TRIPP
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6001 HIGH BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720-5205
Mailing Address - Country:US
Mailing Address - Phone:301-262-4956
Mailing Address - Fax:
Practice Address - Street 1:6001 HIGH BRIDGE RD
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20720-5205
Practice Address - Country:US
Practice Address - Phone:301-262-4956
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-02
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD23004183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist